1. Long‐term molecular remission in a patient with acute myeloid leukemia harboring a new NUP98‐LEDGF rearrangement
- Author
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Natacha Maillard, Nathalie Sorel, Jose Miguel Torregrosa Diaz, Jean-Claude Chomel, Arthur Bobin, Deborah Desmier, Xavier Leleu, Sabrina Bouyer, Françoise Brizard, Maria Pilar Gallego Hernanz, and Elodie Dindinaud
- Subjects
Male ,0301 basic medicine ,Cancer Research ,Karyotype ,Azacitidine ,Biology ,lcsh:RC254-282 ,Fusion gene ,03 medical and health sciences ,Exon ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Original Research ,Cancer Biology ,Adaptor Proteins, Signal Transducing ,Gene Rearrangement ,Remission Induction ,Alternative splicing ,Myeloid leukemia ,Gene rearrangement ,Middle Aged ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Neoplasm Proteins ,Nuclear Pore Complex Proteins ,Transplantation ,Leukemia, Myeloid, Acute ,Leukemia ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Mutation ,Cancer research ,Gene Fusion ,Follow-Up Studies ,Transcription Factors ,medicine.drug - Abstract
A large variety of molecular rearrangements of the NUP98 gene have been described in the past decades (n = 72), involving fusion partners coding for different transcription factors, chromatin modifying enzymes, as well as various cytosolic proteins. Here, we report the case of an AML‐M2 patient with a variant NUP98‐LEDGF/PSIP1 gene fusion (N9‐L10). In this patient, three different NUP98-LEDGF fusion mRNAs were characterized due to alternative splicing in LEDGF exon 11. Targeted high‐throughput sequencing revealed the presence of IDH1, SRSF2, and WT1 additional pathogenic mutations. To improve the therapeutic monitoring, quantification of NUP98‐LEDGF mRNA by real‐time PCR was developed. Because of poor response to conventional chemotherapy, allogeneic stem cell transplantation was performed, followed by 20 cycles of azacitidine‐based preemptive treatment of relapse. More than 31 months after diagnosis, corresponding to 25 months post SCT and 4 months after the last cycle of azacytidine, the patient is in complete molecular remission (undetectable NUP98‐LEDGF mRNA transcripts). This study highlights the considerable variability in breakpoint location within both NUP98 and LEDGF, associated with alternative splicing affecting LEDGF. It also emphasizes the need to fully characterize the breakpoints within the two genes and the identification of all fusion mRNAs, particularly for the development of a molecular monitoring assay. All these data seem critical for the optimal management of NUP98‐LEDGF + hematological malignancies commonly associated with a poor prognosis.
- Published
- 2019